Hip bursitis develops when one of the fluid-filled sacs (bursae) cushioning your hip joint becomes inflamed, most often from repetitive friction between a thick band of tissue on the outside of your thigh and the bony point of your hip. About 15% of women and nearly 7% of men between ages 50 and 79 experience it on at least one side, making it one of the more common sources of hip pain in middle-aged and older adults.
How the Inflammation Starts
Your hip has several bursae, but the one most commonly affected sits over the greater trochanter, the bony bump you can feel on the outer side of your hip. A thick strip of connective tissue called the iliotibial band (ITB) runs over this bump every time you take a step, climb stairs, or bend your hip. When that motion happens too often, too forcefully, or under too much tension, it creates friction against the bursa and the tendons that anchor your gluteal muscles to the bone.
That repeated friction causes microtrauma to the gluteal tendons (mainly the two deeper muscles of your buttock) where they attach to the trochanter. The bursa, whose entire job is to reduce friction, absorbs the excess mechanical stress and becomes irritated and swollen. In some people, the ITB itself thickens over time from this repetitive motion, which only increases the pressure on the bursa underneath.
A related condition called “snapping hip” illustrates this clearly. The ITB catches and snaps over the trochanter as the hip moves from a straightened to a bent position, sometimes producing an audible pop. That snapping creates a concentrated burst of friction with each cycle and can directly trigger bursal inflammation.
Repetitive Activities and Overuse
Because the underlying mechanism is friction, any activity that repeatedly cycles the hip through the same motion can set off bursitis. Running, cycling, and stair climbing are the most frequently cited triggers. All three involve repetitive hip flexion and extension under load, which drags the ITB back and forth across the trochanter hundreds or thousands of times per session.
You don’t have to be an athlete. Walking long distances on uneven terrain, standing for extended periods with your weight shifted to one side, or even routinely crossing your legs can create enough cumulative stress. The common thread is sustained, repetitive loading of the outer hip, especially if the surrounding muscles are weak or tight and can’t absorb the forces effectively.
Falls, Impacts, and Prolonged Pressure
Not all hip bursitis builds up slowly. A direct fall onto the side of your hip can inflame the bursa in a single event. The impact compresses the bursa against the hard bone of the trochanter, causing immediate swelling and pain. Even bumping your hip hard against a table or doorframe can be enough.
Prolonged pressure matters too. Lying on one hip for an extended period, whether during sleep or bed rest after an illness, applies constant compression to the bursa. Over hours, that sustained pressure mimics the effect of an impact injury and can trigger inflammation even without a dramatic event.
Posture, Gait, and Body Mechanics
The way you stand and walk plays a significant role. Lower back pain, for instance, often causes subtle changes in your gait as you compensate to avoid discomfort. Those compensations shift mechanical loads to the outer hip in ways you may not notice. Research has identified gait alteration from back pain as a predisposing factor for trochanteric bursitis, along with prolonged rest positions that put static tension on the gluteal muscles.
Some textbooks have traditionally pointed to leg length differences as a cause, suggesting that the longer leg bears more stress on the abductor muscles and outer hip. Gait analysis does show greater forces through the longer limb and increased pelvic drop toward the shorter side. However, a study published in Arthritis Research & Therapy found no evidence that leg length inequality actually increases the risk of trochanteric pain. The mechanical logic is plausible, but the clinical data doesn’t support it as a standalone cause.
What does matter is muscle imbalance. Weak gluteal muscles force the ITB and surrounding structures to work harder during walking and standing, increasing friction at the trochanter. Tight hip flexors or a tight ITB compound the problem by keeping tension high across the bursa even at rest.
Hip Surgery as a Trigger
Hip bursitis is a recognized complication after total hip replacement. In a study of over 1,000 patients who had the procedure, about 9.4% developed trochanteric bursitis afterward, typically around 10 months post-surgery. Interestingly, researchers initially suspected that changes in bone offset or leg length during surgery might be the cause, but analysis showed no association between those surgical variables and bursitis risk. The strongest predictor was sex: women had a 1.79 times higher risk of developing bursitis after hip replacement compared to men.
The surgery itself disrupts the soft tissues around the trochanter, and the rehabilitation process involves repetitive hip motions during a period when the muscles are still healing. Both factors likely contribute.
Inflammatory Conditions and Systemic Disease
Certain medical conditions make your bursae more vulnerable to inflammation regardless of mechanical stress. Rheumatoid arthritis, which causes widespread joint inflammation, can target the bursae directly. Gout, where uric acid crystals deposit in and around joints, can inflame bursae the same way it inflames joint linings. Diabetes also increases bursitis risk, likely through its effects on tissue healing and chronic low-grade inflammation.
In rare cases, bacteria can infect a bursa directly, usually after a skin break near the hip or through bloodstream spread. Infected (septic) bursitis is a different and more urgent condition than the typical overuse variety, causing redness, warmth, and sometimes fever alongside the pain.
Why Women Are Affected More Often
The gender gap in hip bursitis is consistent across studies. Women develop it roughly twice as often as men. Several anatomical factors contribute. Women tend to have wider pelvises, which increases the angle at which the ITB crosses the trochanter and amplifies friction. Hormonal changes after menopause also reduce tendon resilience and may make the gluteal tendons and bursae more susceptible to microtrauma. The post-surgical data reinforces this pattern, with female sex being the single strongest risk factor for bursitis after hip replacement.
Trochanteric vs. Iliopsoas Bursitis
When people say “hip bursitis,” they almost always mean trochanteric bursitis, which causes pain on the outer hip. But a second type, iliopsoas bursitis, affects a bursa at the front of the hip and causes pain in the groin area instead. Both are driven by repetitive trauma and overuse, but they feel quite different. Trochanteric bursitis hurts when you press on the side of your hip or lie on it at night. Iliopsoas bursitis hurts with deep hip flexion, like pulling your knee toward your chest or getting out of a car. The distinction matters because the aggravating movements and the muscles involved in recovery are different for each type.